Application and Consent Form

Student Application

Name:

Address:

Home Phone: Cell Phone: Email:

Other Student Activities/Organizations:

Indicate why you want to participate in the Mentoring Program:

Is there a specific life skill that you are looking to improve or learn?

 

By signing below, I agree to abide by the guidelines outlined, if selected to participate in the Mentorship Program. I have read and understand the guidelines of both students and mentors who are selected to participate in the Total Package mentoring program.

Signature: Date:

Application and Consent Form

Parent/Guardian Consent Form

Date: ________________, 2009

Dear Parent/Guardian:

Your child, _______________________(full name), has been selected to participate in a after school mentorship program, TOTAL PACKAGE PROGRAM, created by Fab-5. The program is designed to develop leadership skills that encompass the following 10 principles. At the same time students will be exposed to various mentors, groups and community leaders that will serve as role models.

“T-Points”:1. Time - time management2. Talent - career development3. Talking - good communication skills4. Taking Tests - academic development5. Temple - say no to drugs, nutrition6. Tour - learning about other cultures, getting a global view of the work7. Taking Charge - becoming a leader8. Teamwork - working with other people9. Taking a stand - decision-making10.Treasures - money management

< talk about curriculum, schedule, evaluation tools etc>

We hope that you will approve of having your child participate in this exciting program at (school ABC).

Please sign and return this form with your consent

1) ____(Initials of parent/guardian) I grant permission for my child, (full name), to participate in the mentorship program “Total Package Program” and any associated activities. I also grant permission for my child to take any pre/post surveys and participate in any focus groups.

_____________________ _______________Parent/Guardian Signature Date

If you have any questions, please call XYZ @ 999-999-9999.

Sincerely,

_______________________________________

Application and Consent Form

Signature of Organization Representative